Abstract

Purpose

Though postoperative radiation for esophageal cancer is offered in selected cases, there is con&fllig;icting evidence as to whether it improves overall survival (OS). We performed a retrospective investigation to analyze the prognosis impact of adjuvant radiation in a large cohort of patients.

The use of PORT was associated with signi&filig;cantly improved OS (p =0.006). The median OS was 31 months in the group receiving PORT and 21 months in the group undergoing surgery alone. The addition of PORT improved OS at 3 years from 38.3 to 45.8% compared with surgery alone. For American Joint Committee on Cancer (AJCC) stage III esophageal cancer (T1-2N2M0, T3N1-2M0, T4N1-3M0), there was signi&filig;cant improvement on OS (p < 0.001) in PORT group, for not only metastatic lymph-node ratio <0.25 (p = 0.047), but also metastatic lymph-node ratio >0.25 (p = 0.013). However, for stages IIB disease (T1-2N1M0) there was no signi&filig;cant differences.

Conclusions

This large population-based analysis supports the use of PORT for pathologic lymph nodes positive stage III esophageal cancer. Our results suggest that a subset of such patients may benefit from aggressive local therapy. As a retrospective study, our results do not have the same strength as a prospective study, however, it provides a basis for the design of future randomized, prospective clinical trials.